Follow-up Of Patients With Upper Gastrointestinal Stromal Tumors And Related Factors Analysis Of The Tumors Invasion Risk

Background and Objective：Gastrointestinal stromal tumors (GIST) are tumors withmalignant potential,10%to30%of GIST are considered clinically malignant. Themalignant potential mainly based on tumor size, tumor location and number of the tumormitotic. With the development of technology and capabilities expand of endoscopic,endoscopy provides a new approach for the diagnosis and treatment of gastrointestinalstromal tumors. EUS is currently the preferred method for diagnosis of submucosaltumor in the digestive tract. It can provide a lot of valuable information for submucosallesions, including tumor origin, size, shape, echo, borders, etc. In recent years, somestudies suggest that EUS features of GIST have a certain relationship with its malignantpotential. For larger lesions in patients with GIST, surgical resection is generally adopted,but for small lesions, treatment has not yet reached a consensus. Our study willinvestigate the relationship of the invasion risk of GIST with the endoscopic andendosonographic feature. Following-up and monitoring of tumor growth, for GISTespecially small upper gastrointestinal GIST provide the basis for the selection ofclinical treatment.Methods: The first part, collecting endoscopy and endoscopic ultrasoundcharacteristics of upper GIST patients diagnosed by endoscopic ultrasound, thencollecting this postoperative pathological examination, analyze endoscopic featurerelation with the malignant potential. The second part, collecting the clinical data ofpatients with upper GIST diagnosed in our hospital from March2003to December2011.Retrospective analysis was carried out and the patients underwent follow-up to analyzeand explore how to select the treatment of upper gastrointestinal GIST. Results: EUS features of GIST （such as tumor size, surface, echo, shape andboundary） were statistically significant correlates of risk malignant potential. Tumorslarger than3cm, especially mucosal ulceration, a non-oval shape, irregular extraluminalborder and heterogeneity will prompt intermediate or high risk malignant potential.Tumors smaller than3cm, with smooth surface, uniform hypoechoic, morphologicalrules and clear boundary will prompt very low or low risk malignant potential. Theaverage follow-up of patients with conservative treatment for24months，then thenumber of patients in each group (≤1cm group,﹥1≤2cm group,﹥2≤3.5cm group)with tumor growth were0.8%,8.8%and12.5%.Conclusions: GIST with EUS features have some relevance， endoscopic andendosonographic feature can predict the invasion risk of GIST. For≤2cm localized uppergastrointestinal stromal tumors, it has low malignant potential, we should recommendpatients regular clinical follow-up. The malignant potential of2-3cm tumors is betweenlow and medium range, and is available for close follow-up or surgical and endoscopicresection, and tumors greater than3cm has high malignant potential, and surgical orendoscopic resection should be taken.